1518902055 NPI number — CHAD HOUGHTON CRNA

Table of content: CHAD HOUGHTON CRNA (NPI 1518902055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518902055 NPI number — CHAD HOUGHTON CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOUGHTON
Provider First Name:
CHAD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518902055
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87499-6210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-326-6400
Provider Business Mailing Address Fax Number:
505-326-4606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 W MAPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87401-5630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-326-6400
Provider Business Practice Location Address Fax Number:
505-326-4606
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  R41412 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10027396 . This is a "LOVELACE HP" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 202008371 . This is a "PRESBYTERIAN HP" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: NM006E26 . This is a "BCBS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 50505271 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: T0539 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 126483 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32157711 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00347383 . This is a "RR MEDICARE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com